CommUnity’s Mobile Crisis Outreach program is getting a new fleet of eight vehicles, as well as three full-time counselors, thanks to a nearly $1 million grant from Iowa City. The addition of staff and vehicles will shorten response times in the area.
Since 2015, the mobile crisis program has dispatched mental health counselors all across Johnson County and Iowa County to help people in crisis. Around 80 percent of calls have been located in Iowa City, 15 percent in Coralville and North Liberty and 5 percent in rural Johnson County, said Mobile Crisis Program Manager Jake Story.
Mobile crisis has available counselors 24/7, 365 days a year, and functions as a jail and hospital diversion program.
“It is a really unique service to meet people where they’re at, if that’s in their home, place of business, at the hospital, at school, wherever the crisis situation is occurring,” CommUnity CEO Sarah Nelson said. “It’s a free service, and it’s available to all residents, regardless of socioeconomic status, regardless of insurance status.”
When CommUnity receives a call, a mental health counselor and the caller decide on a place to meet, whether that’s in a grocery store, a public park, their home, anywhere. Counselors work to de-escalate the crisis and help people understand what’s going on. When someone feels comfortable, the counselor presents some mental health options in the area and/or safety planning, and then check back the following day.
“It’s very client centered, in the sense that the client really is the one making decisions about how we move forward,” said Story. “We’re there just presenting them with options of how we can support them.”
CommUnity responds to mobile crises in Johnson County within an hour of the initial call. In Iowa City, that response time is typically around 24 minutes; they hope to reduce that to between 15 and 20 minutes.
Before the Iowa City Council approved the grant for the mobile program, CommUnity had two vehicles and around 30 on-call counselors, Story said. Under the on-call model, counselors aren’t stationed in an office.
“They’re kind of doing their thing, going about their business, going about their life, and available to drop what they’re doing, and respond when calls get dispatched to them,” Story said.
The full-time counselors, however, can meet someone as soon as the phone rings. And the additional vehicles will allow on-call councilors to respond faster. On-call counselors can’t use their personal vehicles to transport individuals because of “insurance weirdness,” Story explained. At the beginning of their shift, on-call staff can check out an agency vehicle, and then respond immediately instead of having to drive to the mobile crisis office after taking a call.
CommUnity is looking for counselors but faces a “hiring crunch.” In its proposal to Iowa City Council, the nonprofit attributed the high turnover in mobile crisis to the hardships of the work, COVID exposure and inconsistent scheduling.
“We would love to have, you know, 15 more counselors on the team. Our hope is to have two full teams on every shift of on-call counselors, and that’s been a challenge,” Story said. “We’ve really struggled to get enough people interested in the positions and hired for the positions right now.”
The mobile crisis counselors are trained to help people experiencing suicidal ideation, provide de-escalation of family conflict, grief counseling, de-escalation of an acute mental health crisis and/or connect people to other resources in the area.
“Suicidal thoughts, concerns about safety … that is probably one of the highest percentages of the types of calls that we have,” he said. “Next to that [are] other kinds of mental health related things — a lot of anxiety stuff when people are in some stage of kind of panic.”
Story said the calls that stick with him usually aren’t the intense ones, though he remembers once responding to scene with a woman who overdosed.
“At one point during the conversation, she kind of stepped away. A few minutes passed, and I had asked one of her friends like, ‘Hey, can we just go check on her and make sure she’s OK?’ And sure enough, they had gone upstairs and taken a bottle of pills. And immediately it was a 911 call,” he recalled.
But most calls are empathetic conversations, Story said. Counselors help a person work through their crisis on site.
“We’re not showing up to take people to the hospital. As a matter of fact, that’s kind of what we’re hoping to avoid,” he said. “So a lot of those conversations are just sitting around talking human to human, and interacting with one another, and helping people feel dignified.”
Story previously worked as a hospital chaplain, which he feels helped prepare him for working in the mobile crisis program.
“Most of chaplaincy training is built around essentially bias recognition and empathy work, which is really kind of foundational skills for any kind of crisis counseling,” he said. “It fits really well, in terms of the kind of face-to-face contact we would have with clients. So that was a nice little happenstance I think.”
Mobile crisis diverts 90 percent of calls away from the hospital or jail, according to CommUnity’s estimates. Counselors stabilize around two-thirds of calls on scene without any additional resources. When people need more support, counselors can transport them to the GuideLink Center, Domestic Violence Intervention Program (DVIP) or other organizations that provide assistance. In the past year, they’ve taken 519 people to GuideLink.
The volume of contacts has risen 506 percent since the beginning of the program, Nelson said. They currently handle over 100 calls a month.
“We are experiencing a significant increase in mental health crises in our community as a result of the pandemic,” she said. “It’s more important than ever to make sure that our services are really robust when it comes to mental health and crisis response.”
CommUnity recently added a mental health liaison embedded within the Iowa City Police Department to assist with calls relating to mental health crises, and they added a youth program coordinator who works with schools and other local youth-specific groups. In the past year, CommUnity has helped 68 youth clients.
Of the $939,082 in funds approved by Iowa City Council, CommUnity will spend $182,720 for the eight new vehicles, $556,362 for three year funding for full time mobile crisis counselors, and $200,000 to remodel the debrief room and five mobile crisis offices.
The grant marks the first expenditure of the city’s $18.3 million in American Rescue Plan Act (ARPA) funds, specifically the State and Local Fiscal Recovery Fund (SLFRF) program. In their meeting on Feb. 15, Iowa City Council unanimously approved CommUnity’s proposal.
“I’m just so pleased to this come before us. It’s an extremely important resolution to come before us to vote on. It’s absolutely necessary,” said Councilmember Pauline Taylor. “We need to really bolster the mobile crisis unit and increase their responsiveness and the quality of services they provide.”
Councilmember Laura Bergus compared mobile crisis to CAHOOTS, a mental health crisis program in Eugene, Oregon, pointing out that Oregon program’s response times are longer than CommUnity’s.
“This is a swift and very important response,” she said. “Having a service like this in our community I just think is tremendous.”
Councilmember Janice Weiner said that as CommUnity’s mobile crisis program becomes embedded in the community, more people will have access to mental health support without needing the intermediary of law enforcement. Mayor Bruce Teague said that he had “first-hand experience” with mobile crisis outreach and mentioned how appreciative people are of the service.
“The stories of individuals that were in crises are very many, and sometimes we never saw them in the crisis stabilization beds because of the outreach that mobile crisis did in really talking to those individuals and giving them the supports that they need,” he said. “Often times it could be somebody’s first time having a mental crisis, where they need to be in a different place other than a hospital or their home or in jail, really. So this a great opportunity for our community.”
CommUnity is one of only two call centers in Iowa that is part of the National Suicide Prevention Lifeline. The other is Foundation 2 Crisis Services in Cedar Rapids. A change is coming to the lifeline service this summer, as a new three-digit number is introduced to allow people experiencing suicidal ideation or a related crisis to be immediately connected to lifeline counselors. The new number, 998, will go live on July 16. (The current National Suicide Prevention Lifeline number, 1-800-273-8255, will remain in service even after 988 starts taking calls.)
“For a mental health crisis, we expect there to be some diversion from 911 over to 988, so we’re preparing for that capacity increase to make sure that we can respond to that volume,” Nelson said.
Story said he’s glad to help grow mental health services in eastern Iowa.
“It’s exciting to be a part of something that is really trying to think more critically about how we make our community safe, and what it looks like to make a community safe … I think that part of the program, in that part of the job right now, is probably the most exciting thing for me,” Story said. “Crisis response is a critical component that has been missing in, you know, municipalities and counties for a long time.”